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Co-morbidities Rather than Age Impact Outcomes in Patients Receiving Preoperative Therapy for Gastroesophageal Adenocarcinoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Older patients with localized gastric adenocarcinoma (LGAC) have substantial postoperative morbidity and mortality; however, postoperative outcomes of the patients who receive preoperative chemotherapy and/or chemoradiation have not been reported. We examined the impact of age at baseline on potential predictors of postoperative outcomes.

Methods

Patients with LGAC who were treated with chemotherapy and/or chemoradiation followed by surgery (n = 203) formed two groups: (1) ≥65 years old (n = 70) and (2) <65 years old (n = 133). We assessed postoperative morbidity and mortality as well as overall survival (OS) and progression-free survival (PFS). Potential predictors of 90-day postoperative outcomes were identified i) by age groups and ii) other clinical covariates. Descriptive statistics and survival analyses were utilized.

Results

90-day postoperative morbidity was similar in older and younger patients (61 % vs 58 %; P = 0.655). 90-day mortality was similar (3 % vs 0 %; P = 0.118). Major Clavien grade III/IV complications were similar (17 % vs 12 %; P = 0.392). OS and PFS were also similar for both groups (P = 0.863 and P = 0.558, respectively). Other factors, such as Charlson comorbidity index (P < 0.001) and median operative time (P = 0.002) were strongly associated with postoperative complications.

Conclusion

Our data show that older patients with LGAC generally have similar outcomes as do younger patients after preoperative therapy but comorbidity indices have significant impact on complications and the long-term outcomes rather than age.

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Acknowledgment

This study is supported by generous grants from the Caporella, Dallas, Sultan, Park, Smith, Frazier, Oaks, Vanstekelenberg, McNeill, Planjery, and Cantu Families. as well as from the Schecter Private Foundation, Rivercreek Foundation, Kevin Fund, Myer Fund, Dio Fund, Milrod Fund, and multidisciplinary Grants from the University of Texas M. D. Anderson Cancer Center, Houston, USA. It is also supported in part by the National Cancer Institute awards CA138671, CA172741, and CA129926 (JAA). Nikolaos Charalampakis has been awarded a scholarship from the Hellenic Society of Medical Oncology.

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Authors and Affiliations

  1. Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA

    Nikolaos Charalampakis MD, Quan Lin MD MS, Elena Elimova MD, Yusuke Shimodaira MD, Kazuto Harada MD PhD, Jeannette Mares MPAS, PA-C, Fatemeh G. Amlashi MD, Mariela A. Blum-Murphy MD & Jaffer A. Ajani MD

  2. Department of Biostatistics, The University of Texas M.D. Anderson Cancer, Houston, TX, USA

    Lianchun Xiao MS

  3. Department of Pharmacy Clinical Programs, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Jane E. Rogers Pharm D, BCOP

  4. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA

    Bruce D. Minsky MD & Prajnan Das MD, MS, MPH

  5. Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Wayne L. Hofstetter MD

  6. Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Aurelio Matamoros Jr. MD & Tara L. Sagebiel MD

  7. Department of Gastroenterology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA

    Jeffrey H. Lee MD, Brian Weston MD & Manoop S. Bhutani MD

  8. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Paul F. Mansfield MD & Brian D. Badgwell MD

  9. Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Jeannelyn S. Estrella MD

Authors
  1. Nikolaos Charalampakis MD
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  2. Lianchun Xiao MS
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  3. Quan Lin MD MS
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  4. Elena Elimova MD
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  5. Yusuke Shimodaira MD
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  6. Kazuto Harada MD PhD
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  7. Jane E. Rogers Pharm D, BCOP
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  8. Jeannette Mares MPAS, PA-C
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  9. Fatemeh G. Amlashi MD
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  10. Bruce D. Minsky MD
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  11. Prajnan Das MD, MS, MPH
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  12. Wayne L. Hofstetter MD
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  13. Aurelio Matamoros Jr. MD
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  14. Tara L. Sagebiel MD
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  15. Mariela A. Blum-Murphy MD
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  16. Jeffrey H. Lee MD
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  17. Brian Weston MD
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  18. Manoop S. Bhutani MD
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  19. Paul F. Mansfield MD
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  20. Jeannelyn S. Estrella MD
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  21. Brian D. Badgwell MD
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  22. Jaffer A. Ajani MD
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Corresponding author

Correspondence to Jaffer A. Ajani MD.

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Charalampakis, N., Xiao, L., Lin, Q. et al. Co-morbidities Rather than Age Impact Outcomes in Patients Receiving Preoperative Therapy for Gastroesophageal Adenocarcinoma. Ann Surg Oncol 24, 2291–2301 (2017). https://doi.org/10.1245/s10434-016-5601-9

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  • DOI: https://doi.org/10.1245/s10434-016-5601-9

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